| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,646 |
2,573 |
$83K |
| D1120 |
Prophylaxis - child |
1,030 |
982 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,488 |
1,423 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,480 |
1,439 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
2,187 |
2,117 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
310 |
168 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
422 |
309 |
$16K |
| D9110 |
|
390 |
375 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
337 |
330 |
$13K |
| D1310 |
|
456 |
442 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
203 |
77 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
135 |
102 |
$9K |
| D2160 |
|
191 |
162 |
$9K |
| D1330 |
|
455 |
441 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
341 |
332 |
$7K |
| D2140 |
|
247 |
170 |
$7K |
| D2332 |
|
95 |
56 |
$5K |
| D2335 |
|
79 |
53 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
441 |
422 |
$4K |
| D2331 |
|
76 |
44 |
$3K |
| D0330 |
Panoramic radiographic image |
90 |
87 |
$3K |
| D5211 |
|
12 |
12 |
$3K |
| D2161 |
|
15 |
14 |
$800.00 |
| D1351 |
Sealant - per tooth |
38 |
12 |
$760.00 |
| D0272 |
Bitewings - two radiographic images |
41 |
41 |
$734.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
12 |
$101.00 |